294 STUDIES ON PATHOLOGIC OVA. 



mens is sometimes very complete, but this is true also of older ones, so that the 

 external form may suggest the amorphous group. An intermediate form between 

 the latter and No. 2014 is represented by No. 1495d (fig. 216), a cyema 12.3 mm. 

 long, but of approximately the same stage of development as the other two. A 

 still more advanced change of this type is illustrated by No. 921, shown in figure 

 39 (plate 4, Chap. IV). The difference in length between some of these specimens 

 of corresponding development is not infrequently due mainly to shrinkage accom- 

 panying maceration and retention. No. 1495d is interesting also because the 

 placental site was marked internally by numerous subchorial hematomata (fig. 

 217). I do not wish to enter into a discussion of these so-called "Breus hema- 

 tomatous moles" of which so much seems to have been made, but all the speci- 

 mens which have come to my attention had been retained for a long time. It 

 would seem that when, for some reason, the placental margins and also certain 

 intermediate placental areas are more firmly adherent than the rest, the looser 

 portions may be detached and forced inward by hemorrhage, thus producing a 

 series of hummocks on the internal surface of the placenta. If the chorion and 

 amnion over these areas rupture, blood may enter the amniotic fluid, and just 

 in proportion as the latter is reduced in quantity the process of eversion of the 

 placental site must be facilitated. It is, of course, entirely possible that a mix- 

 ture of blood with the amniotic fluid, so common in these specimens, may help 

 to preserve the cyema, but the abortuses with subchorial hematomata which I 

 have seen did not give me the impression that their preservation was any better 

 than that of the non-hematomatous type. 



Blunting and rounding of the extremities of the cyema, with consequent 

 shortening and loss of detail, are present in still more decided form than previously 

 illustrated. Beginning sagging of the extremities is shown well in No. 1358, 

 which is 18.3 mm. long, and in still older specimens, such as No. 1710 (fig. 66, plate 

 5, Chap. IV). The abnormal curvatures, and especially the blunting of the ex- 

 tremities, are exemplified still better, and the drooping mandible, gaping mouth, 

 and locally edematous cord are also well shown in No. 797, a fetus 35 mm. long, 

 represented in figure 218. Changes in curvature of the extremities are splendidly 

 illustrated in No. 1860 (fig. 219), and become more pronounced the older the 

 specimen, up to the period when skeletal development makes them extremely 

 difficult or even impossible. 



The changes in the extremities do not stop, however, with the production of 

 abnormal curvatures, for not infrequently the hands and feet undergo an outward 

 clubbing, shown in pronounced form in No. 1958 (fig. 220), a decidedly macerated 

 specimen 41.5 mm. long. Separate views of the extremities of this specimen are 

 given in figures 221 and 222. Earlier stages in this process are illustrated by No. 

 1751 (fig. 223) , with separate views of the extremities in figure 69 (plate 5, Chap. IV) . 



Since the extremities in earlier stages of development are less resistant, they 

 become soft and are more easily contorted ; but at a somewhat later stage of develop- 

 ment, when they are more resistant, it is not uncommon to find the arms especially 

 assuming more extended positions of gesture. Hence grotesque figures occur, such 



